232 Renal disease, treatment of Solution, waterproof Sphacelus and Esophageal inflammation Spirit of Medical Press, 16, 29, 52, 65, 76, 88, 184, Intestines by Omentum Stricture of Urethra 251 Sketch of French Surgeons and Surgery Skin, diseases of 51, 61, 73, 85, 97, 107 phalus 37, 49 224 107 92 188 88 Small Pox, Lawrence on 85 47 7 Foreign 83, 154, 166, 178, 191 112 223, 248 Unions, medical relief in 9 29 Universty of London, examinations at, 187, 199, No. 27. VOL. II. THE MEDICAL TIMES. A Journal of English and Foreign Medicine and Medical Affairs. LONDON, SATURDAY, MARCH 28, 1840. PRICE THREEPENCE. STAMPED EDITION, 4D. For the convenience of Subscribers in remote places, the Weekly Numbers are reissued in Monthly Parts, stitched in a Wrapper, and forwarded with the Magazines.-Subscriptions for the Stamped Edition for circulation Post-free in advance, are received at the Medical Times Office, 10, Wellington-street North, London. Subscription, Quarter, 4s. 4d.; Half-Year, 86. 8d.; Year, 17s. 4d. MEDICAL PORTRAITS. THE PROFESSION IN DUBLIN. [8. SMITH, WELLINGTON STREET NORTH, STRAND.] LECTURES ON SURGERY. DELIVERED AT ST. BARTHOLOMEW'S HOSPITAL, BY CARCINOMA. without profit. He is thoroughly master of his subject, and has the power and desire to communicate all he knows in the readiest manner; and then he so lightens the dry details of mere descriptive anatomy, by little scraps of phy- MALIGNANT DISEASES-SCHIRRUS; CANCER; siology and practical points in surgery, that he THE affections, gentlemen, of which I have engages and fixes the attention from his first to hitherto spoken, are all of them of a curable his last word. Some of the older students nature; and in many instances, though attended complain that he gives nothing but his 'Dublin with great temporary disturbance of the part, and with a serious influence on the system at large, Dissector,' and 'Harrison on the Arteries,' over yet the derangement is of a temporary kind; and and over again." "But this, in my opinion, is after going through a certain process the part reno fault. Who is he like here?" "Why, just covers its functions; or at all events, even if it imagine Bransby Cooper, without his action have become seriously injured in that respect, it may recover so far that the life of the individual and gesture, and you have the very man." is preserved. I now proceed to mention some af"Who was he?" Why I hardly know, but fections that seem to be essentially of a destruche was apprenticed at Stevens' Hospital, and tive character-in which there is not the same afterwards went to Paris. Then he married salutary tendency as in those that we have hitherto considered; not the same natural disposition either a daughter or sister of Abraham to recovery after going through the diseased proColles, and the old boy pushed his relation into cess, but where the nature of the action tends to the College school. He and Jacob lectured the destruction of the textures of the organ in which it is seated, and which even proceeds to the together, and had a capital class. When destruction of life. Such seems to be the essenMacartney resigned at the University, the tial character of the affections that I am now gocolleagues both canvassed for the vacancy, and ing to describe to you; and hence they have been called malignant diseases, in opposition to the Harrison got it with flying colours. Old Jacob former.-The diseases which we call cancer, funhas hated him most cordially ever since, and gus hæmatodes, and melanosis, all of them agree never passes his house without mentally consign-in the two points that I have now mentioned; ing him to the pit that is bottomless. But I'm that is, they completely destroy the natural texture of the part in which they take place, and they in a hurry now, and I'll tell you all about the also proceed to affect other parts besides those in rest of them next time we meet. Good morn-which they primarily originate, by which extening." sion they destroy the life of the individual. In these leading features, cancer, fungus hæmatodes, and melanosis, severally agree; and hence they are very commonly described together, and have been regarded by some as one affection. There is, however, an essential difference between them : although they have the same destructive tendency in relation to the parts and the life of the individual, yet they differ in the nature of the changes which they produce in the affected part, and they differ in the age of the individuals whom they attack, as well as in respect to certain other points "WHO are the principal medical men in Dublin?" asked an old friend of ours a few days since. "Lecturers or Practitioners?" said we. Why both," was the reply; " don't Lecturers practise?" "Yes certainly," said we, "but there are few who stand well in both capacities. The profession is brought to such a state by the fee system, none but the pure shop apothecaries sending out their own medicine, that the bulk of the practice is thrown into the hands of a few. Mr. Snooks, the bootmaker, will not pay his next door neighbour a guinea for a prescription, when he can get one of Sir Philip Crampton, or Sir Henry Marsh, at the same rate. This result was foreseen by those gentlemen who so disinterestedly brought about the present state of things. I am personally acquainted with many men of talent, highly educated, and of great perseverance, who after being from five to fifteen years in practice, have not made enough by their profession to pay their house-rent. Well, the men thus fully employed have very little time for lecturing, and then most of the chairs at the different schools are filled by men who devote the principal part of their time to teaching, and thus earn a precarious livelihood." "But Stokes, Graves, Corrigan, Adams, and so on, have a BRITISH MEDICAL ASSOCIATION.-The good deal of practice, and they lecture," retorted deputation appointed to wait on the SolicitorAmicus. "So they do," was the answer, and General, Sir Thomas Wilde, M.P., reported to they are about all you could name, with the the Council, that they had waited upon Sir exception of one or two perineum supporters. Thomas last week by appointment, and had One half of the younger practitioners get their been very kindly received. He promised to living either by demonstrating or grinding; present the petition, and stated that he would some of them make perhaps a couple of hun-attend to the subject of Medical Reform, and dred a year in this way, and are so perfectly He would willingly receive any papers, or any make himself acquainted with its bearings. innocent of practice, that one of them told me facts, from the Association, connected with the ture of the organ in which it is seated, and the he had taken but two fees in five years!" question; and, if it was desired, would again principal character of which is an unnatural hardWell, but do you mean to say that there are confer with the deputation. He could say at ness or induration. It may, or may not, be acstudents enough in Dublin to support men by Medical Reformers as led them to demand such of structure then proceeds into a state of ulceraonce that with so much of the sentiments of companied with swelling of the part. The change lecturing alone, and the fees so very low?" a reform of the medical corporations as would be tion; it does not remain limited to the organ in "Yes, there's Harrison for example. Nobody analogous to the reform of the municipal cor- which it has first arisen, but extends to the neighsuspects him of making much in any other porations, he could agree. It was his opinion bouring parts. It shows itself in other forms in way, though he is Surgeon to Jervis-street that all governing bodies existed for the advan- the internal organs of the body; it produces pain, Hospital. He is Professor of Anatomy and tage of the members at large, to whom they emaciation, and serious constitutional affections; and by the progress of the local symptoms in the Surgery in the University, for which he should be responsible. gets two hundred a year, and the fees of the Journal of Medical Science' for the current The swelling and induration of the part which MR. HALPIN, of Cavan, in the Dublin part first affected, and by the increase of those constitutional symptoms, it destroys the patient. pupils. He had upwards of a hundred and month, strongly recommends a novel mode of constitute the first stage of the disease, are detwenty last session. The fee for anatomy remedying retroversion of the uterus, which nominated schirrus. The disease is called schirrus and physiology is three guineas, surgery two was successfully resorted to by him in one in- in that early state of its development. The word stance. The apparatus made use of consisted cancer or carcinoma is more properly applied to guineas; so take the average at four guineas, merely of a bladder, which, being introduced the ulcerated stage, carcinoma being equivalent to he clears near seven hundred a year." "A into the vagina, was then inflated, and equable what, in common language, is called open cancer. pretty thing, too; what sort of a fellow is he?" and gradual pressure thereby applied to the The essential nature of the disease, then, seems to "In person he is a stout bustling little fellow, displaced organ. Mr. Halpin notices the diffi- consist in the succession of these two stagesmore like a country auctioneer than a Univer- culty usually experienced in catheterism in that of induration and that of ulceration. Now sity Professor. As a lecturer he is very much cases of retroversion of the uterus, expressing writers to any hard enlargement of an organ, liked; his surgical lectures are very poor, but his preference for a long elastic catheter, which without considering whether this is of a nature as a demonstrator he stands unrivalled in Dub-may often be advantageously substituted for likely to proceed to the subsequent change of carthe ordinary silver instrument. lin." in their course and termination. Cancer consists in a peculiar change of struc the word schirrus is applied frequently by modern cinoma or ulceration. In this sense the word is eases. In his article on the subject of schirrus, "What is his style?" "Earnest sim- The funds of the General Dispensary, Lime-applied by Boyer, in his treatise on surgical displicity. No one can attend in his theatre rick, are completely exhausted. he merely defines it as enlargement and indura-trude themselves on the notice of the patient. The suffering to the individual. During the time that tion of a part; and says that schirrus sometimes tumour becomes painful; it increases in size; some this change is going on, the health of the patient proceeds to cancerous ulceration, and in other in- degree of heat, and sometimes a degree of redness becomes considerably impaired. Sometimes, howstances does not. Now the mere character of and swelling of the breast generally, are perceived. ever, before the disease has gone to the state that hardness is not in itself a proper basis for dis- When we come to examine the swelling at this I have mentioned, ulceration commences in the tinction in pathology. Varions affections, different time-and this is the period when it is usually original tumour, and we find this takes place in two in their essential nature, agree in possessing that submitted to our examination--we find it charac- ways. Sometimes the ulceration is superficial, single character. The mere circumstance, there- terized by a peculiar incompressible hardness, and produces but little discharge, which however fore, of consistence, is not of itself a sufficient possessing nothing like elasticity to the feel. You encrusts, so that there is a kind of scale formed on ground of distinction on which to establish a par- cannot compress it; it has almost the hardness of the surface of the part: this is more particularly ticular class of diseases. I think, therefore, it is a stone or solid substance. The surface of the the case where the integument is drawn in, in the best to keep to what writers in this country now tumour is generally uneven, more or less knotted form of the deep folds that I have mentioned, over do, namely, to restrict the term schirrus to those or tuberculated. It is loose and moveable, not the tumour. The ulceration comes on in the form changes in the structure of a part which will sub-adherent to the pectoral muscle or integuments; of a crack at the bottom of one of these folds; the sequently ulcerate and become carcinomatous. so that you can move it about easily, and it feels discharge that takes place from it encrusts over Intractable ulcerations affecting the skin, although circumscribed. On examining the breast care- the surface, so that the patient is hardly aware they may not have been preceded by obvious tu- fully, you usually observe, particularly if the that ulceration has commenced; but more commour, or in a state of schirrus induration, gene- tumour is increasing, that the superficial veins of monly a nipple-like prominence (one or more) rally pass, particularly in common language, under that side are much larger and more conspicuous takes place on the surface of the tumour, and bethe name of cancer; in fact, that seems to be the than they are on the other side of the chest. comes of a red colour; the tumour, which before form which cancer generally assumes when it affects Sometimes they almost assume a degree of vari- was incompressibly hard, now begins to get soft the cutaneous texture; so that, perhaps, if we cose enlargement, but usually in the active period in the situation of these prominences; the skin were to employ the term very strictly, we should of the disease there is a marked difference between becomes thinner and thinner, assuming a livid find that we could hardly lay down as a general the superficial veins of the two sides of the breast. colour, and finally gives way; and you generally rule, the necessity of any previous existence of The pain at the commencement of the tumour is find that a discharge, of an ichorous fœtid nature, schirrous enlargement. Now we generally see not in general constant; it generally comes on at takes place from the surface. This is the most cancer occurring as a change in some particular particular periods, and then ceases for a time; it common form of carcinomatous ulceration. When organ: however, cancerous structure, that is, is of a darting or shooting character, and such as the skin has given way, you find an extensive schirrous enlargement which proceeds subsequently has been called lancinating. Then the patient is ulceration taking place in the surface of the tumour, to ulceration, may occur as a newly-formed tu- sometimes quite easy; but all of a sudden a sharp and a deep irregular excavation is speedily formed mour in any part of the cellular texture of the darting pain is experienced in the part, and fre- in it. The parts are removed by ulcerative absorpbody, like other tumours; this, however, is not quently at this period the pain is very severe. tion, and frequently there is the appearance of common. The parts of the body which are most About the same time we usually find that the something similar to sloughing, by which the subject to cancer are, in the first place, the female lymphatic glands of the axilla become affected. ulcerated cavity is increased that is, a part of breast, the stomach, or at least certain parts of it, You find, perhaps, one or more of them enlarged; the surface of the sore assumes a kind of ash(the cardiac and pyloric extremities,) the rectum, and some pain is experienced in the gland, of a coloured appearance, seems to lose its vitality, and the uterus, the lip, the tongue, the penis, the testi- kind similar to that which is felt in the tumour.separates like a slough. The discharge that takes cle, and the ovary. These are parts in which In the progress of the affection we soon find that place, whether the process is of one kind or the schirrus occurs primarily; but in the advanced the disease begins to extend from the circumscribed other, is never at all like pus-it is always thin stage of cancer, secondary depositions of a cancer- tumour, of which it at first consists, to the sur- ichor, and in general very fœtid. When the ulcer ous nature, may take place in a great variety of rounding parts. In the first place the skin be- has become of considerable size, we usually find parts of the body. The absorbent glands com- comes adherent to the swelling upon the most that the edge is elevated, and probably everted; monly become affected; the lungs, the liver, the prominent point; it is fixed to it; and frequently, there is a large rising margin, and considerable bones, and various internal parts, may be the in consequence of this, the skin appears to be excavation in the centre; the bottom and sides seats, in a secondary way, of cancerous affection. drawn or tucked in opposite to the swelling, so are very irregular, sometimes presenting a bright It is often stated in the accounts of those parts that you see the situation of the swelling by this red appearance, like granulations, sometimes prewhich are most frequently the seat of cancer, that retraction of the skin. Sometimes a deep fold is senting the ash-coloured sloughs that I have menthe testis of the male, and the ovary of the fe- produced by this adherence of the skin to the tioned, and in the separation of these it not male, are among these; indeed, you will find tumour: at the same time it is not uncommon to uncommonly happens that considerable bleeding that the testes and the ovaria are often enume- observe a retraction of the nipple, so that you find occurs. This process of ulceration is attended rated as parts particularly subject to cancer. the nipple of the affected breast considerably less with excessive, constant, burning pain. If the This I consider to be by no means a correct repre-elevated than that of the opposite side; sometimes pain has been at all of a variable character before sentation, if we confine the term cancer to the change I have mentioned; for in that case we should say that schirrus, and the subsequent transition into cancerous ulceration, are extremely rare, both in the testes and ovaria. it is, in fact, completely drawn in; and occasionally -that is, if the patient has occasionally been free you find, instead of forming a prominence, that from it-when this kind of ulceration takes place, the nipple is situated at the bottom of a depres- the pain will be found to be constant and very sion-the retraction is so considerable. The tumour, severe.-When the complaint has arrived at this after it becomes adherent to the skin, sometimes stage, the most unequivocal marks of serious conNow, in order to give you a general notion of is also fixed to the pectoral muscle. The cellular stitutional affection are perceived. This has been the nature of cancer, I believe it will be the best texture which intervenes between them becomes called by some writers the state of cancerous caplan to describe the course which the disease takes consolidated, and the tumour can no longer be | chexia;-the French particularly describe it. We in the female breast; for the observations that I moved laterally on the surface of the muscle. find that the patient is pale, sallow, and has a shall have to make to you respecting the nature After some time the mammary gland, together kind of leaden appearance of the countenanceof the diseased change, its course, and ultimate ef- with the skin which covers it, and the pectoral that there is considerable emaciation-that the fects, as well as respecting the ages of those that muscle, form one hard mass, very firmly connected pulse is accelerated, and the functions of the stoare subject to it, and the kind of treatment that to the surface of the chest, and not admitting of mach and digestive organs disturbed; but the is appropriate, will be applicable to the disease being moved on the parts beneath it. The swelling constant and severe pain renders the patient almost generally; but we shall understand the matter in the axilla increases; the disease occupies the incapable of getting rest, and, in fact, a state more better by this kind of individual example than if whole mass of the absorbent glands there, and or less like that of hectic is produced. In this we were to make a series of general remarks.-The constitutes a firm solid tumour, which becomes state it commonly happens that the breathing bedisease, at the commencement of its attack on the fixed in the axilla in the same way as the schirrous comes affected-a difficulty of respiration comes female breast, by no means presents that for- breast itself is fixed on the chest. At the same on, cough occurs, and the patient sinks under the midable character which it shows in its progress period you very probably find that the lymphatic effect of the local disorder, and the consequent and termination; indeed, for a certain period, it glands that are situated above the clavicle about constitutional disturbance that it produces. exists merely as an indolent swelling in the breast, the root of the neck become enlarged; and the which is hardly noticed by the individual in whom progress of the affection that I have now described it takes place. It very commonly happens that is attended with considerable increase in the sufthe female discovers by accident the existence offerings of the patient. The pain that only took a schirrous lump in the breast; and that when place occasionally becomes more constant and more she first perceives it, it has already attained a con- severe, and the health of the patient begins to be siderable size. She finds, perhaps, a lump, the affected. As soon as the glands enlarge above the size of a walnut, without being previously aware clavicle, you will find that oedematous tumefaction that any disease existed in the part. In this indo- takes place in the upper extremity; in fact, the lent state the schirrous lump will often remain for whole mass of the lymphatic glands connected many months, or even some years-for two or with the arm, those in the axilla, and those above three years, not enlarging nor producing any pain. the clavicle, become the seat of disease. Hence There is a hard tumour, which is loose and move- the intersticial absorption of the limb is put a stop able; no discolouration of the skin, and no uneasi- to, and edematous tumefaction is the result. It ness perceived in it. After a time, however, the sometimes increases to a great extent; the limb disease loses this indolent character, and assumes a augments in size; and being accompanied with much more active progress, with symptoms that ob-inflammatory action in the part, it occasions great When we examine the part, we find that the natural structure of the mammary gland is no longer recognisable-it seems as if it had been removed, and in the place of it that peculiar texture that characterizes schirrus, had been deposited. This texture consists of a very hard dense substance, which approaches in consistence almost to that of cartilage; when you cut through it with a knife, you experience the same sort of resistance that you do in cutting through cartilage-it has a kind of semi-transparency, a slightly yellow colour, and it is so hard that we can make no impression at all upon it with the handle of the knife; it is quite homogeneous, very dense indeed, and if you cut thin portions of it, you see that it is semitransparent. In this structure you will generally observe, however, on close inspection, that there is an intermixture of white points and streaks disseminated pretty generally through it. particularly, where the shrinking and diminution cancerous disease, instead of the affection being part of the chest, from the clavicle down to the confined to a single small tumour. When the upper part of the abdomen, presented a sort of Sometimes the cancerous structure appears to us whole gland is thus the seat of the disease, it mass, rather of a carcinomatous substance than of as a distinct and circumscribed tumour, the limits of generally happens that it increases in size, or is muscle or mammary gland; but, in fact, there which are well defined; but in other instances por-swollen, but not considerably so. When, there was nothing left but an irregular indurated mass, tions of this cancerous structure extend from the fore, you see any large swelling of the breast, you as hard as cartilage, and adhering to the integuoriginal seat of disease into the neighbouring parts, may know perfectly well that this is not schirrus. ments of the chest. When she first came to the forming a striking contrast in appearance with the Frequently, indeed, the gland, instead of being hospital there was a large ulceration occupying the adipose substance which separates it from the other increased in size, is diminished-it undergoes a interval between the two breasts; there was much textures. The absorbent glands of the axilla as- kind of shrinking from absorption. To use the pain and inflammation about the parts, and the sume a similar appearance they seem to be con- expression employed by the French, sometimes it ulcer was in a foul state; but in other respects verted into a texture very much like that of the is affected with hypertrophie-that is, enlarge- she was in good health, and you could not have original tumour. ment;-sometimes with atrophie-that is, shrink- said that there was anything the matter with her. In the early stage of the affection of the absorbing or diminution. It is in the latter case more She looked well in the face-eating, drinking, and ents, it is not unlikely that the glands may be ensleeping tolerably well. The application of leeches larged simply by irritation, just as the absorbents gave her very great relief; in fact so great, that durare by the irritation of ordinary disease in a part; ing two or three months she staid in the hospital, but very soon we find that the glands have the Frequently in the progress of the affection, the sore almost completely cicatrized. She lost same firm, incompressible hardness which belongs after the mammary gland itself has become the seat the pain in the chest, and regained her health; to the original tumour, and we find when we come of disease generally, or when it has proceeded to so that she went out of the hospital with the sore to examine them after death, that they exhibit the ulceration, you have cancerous tubercles developed nearly healed, and she looked so well that a persame kind of dense or cartilaginous change of in the skin in the circumference of the gland- son seeing her dressed, and not knowing the state structure. However, the changes of structure that small lumps about the size of peas or beans--little of her chest, would not have suspected that she take place in cancer, are not confined, in cases that hard knots in the skin. These frequently assume had any disease whatever. I mention this to proceed to a fatal termination, to the parts that are a red or livid colour, become extremely sensitive, show, that although cancer is to be regarded in the original seat of disease: when we come to ex- very painful, and occasionally go into a state of general as an incurable affection, yet, under ceramine the body, we find that the absorbent glands | ulceration. There are considerable varieties ob-tain circumstances, it does admit of being healed. that are seated on the interior surface of the sternum, served in the progress of the affection, as to the This patient was out of the hospital some months, and anterior part of the mediastinum, are enlarged, length of time that it occupies. Generally speak- and returned again labouring under symptoms of and that they have undergone a schirrous change. ing, we find that it proceeds more rapidly in pro- acute inflammation of the chest. She was adThe absorbents from the breast partly take their portion as the subject is young; its progress is mitted for this complaint, and died in consequence course between the cartilages of the ribs to the more slow in persons advanced in years. But of it: we had an opportunity of examining her inside of the chest, and thus it is that the glands there are also differences in its progress that we after death. The disease had existed in this indibecome affected. On dissection we generally find cannot ascribe to the age of the patient, but which vidual nearly twenty years. She was about fifty that the cancerous tubercles, if we may so call them, seem to arise from some difference in the nature when she died, so that it had begun when she was are deposited in the lungs, and not uncommonly of the affection itself. about the age of thirty. There was very conin the liver also. These are white and tolerably I have mentioned that the tumour commonly siderable thickening of the pleura and of the firm depositions, which are usually found in the remains in an indolent state perhaps for several upper part of the peritoneum. It would seem as greatest abundance immediately under the serous months-or it may even remain in that state for if this long-continued disease in the neighbourmembrane of the lungs; but they are also disse- two or three years, or more. When the more ac- hood of these serous membranes had gradually minated throughout the substance of these organs, tive state has begun, we then find that it gene- extended to them by continuity, and produced and not uncommonly similar depositions exist in rally terminates fatally, at all events within two or considerable alteration of their structure-a sort of considerable abundance through the whole tex-three years; frequently it ends in a year, or little cancerous change of structure, with a granular and ture of the liver. Other internal organs are like-more, from the time that the more active growth indurated surface. There was also in her case a carwise found occasionally to be the seat of the has commenced. I had occasion to remove the tilaginous thickening of the pericranium, covering disease, such as the uterus. Tubercular deposi- mamma of a lady, and at the same time that she a part of the skull, and a corresponding change of tions of a schirrous kind have been seen connected discovered the lump there was also a swelling in texture of the dura-mater. In a healthy person with the mucous membrane of the stomach, and the axilla-so that at one and the same time she the progress of the cancerous disease is often so of the alimentary canal. In proof of the exten- found out the existence of the schirrus in her slow that it does not materially shorten life. You sive mode in which the system is generally affected breast, and change in the state of the axillary may see a lump in the breast that is decidedly in the termination of these cases, I may observe glands, consequent thereon. I removed the part schirrus-the integuments may become adherent that sometimes bones themselves are changed in for her. When I came to perform the operation, to it, and both become adherent to the chest; a their structure that there is a partial removal of however, I found a much more extensive disease kind of superficial ulceration will take place, atthe earthy matter belonging to them, and a depo- in the axilla than I had expected when I com- tended with slight encrustation; and this state of sition in its stead of a kind of cancerous texture. menced it; and I mention the circumstance to things will last for a number of years, and perhaps This is found chiefly in cases where cancer has ex- you as a caution. In these cases you find the does not apparently accelerate the descent of the isted for a great length of time, and hence the whole chain of the axillary glands diseased, when individual to the grave. I am acquainted with a long bones of the body have sometimes been perhaps you only expected to find a single gland lady whom I have seen various times for six or broken by slight causes, such as turning in bed. enlarged. It is proper, as far as possible, to as- seven years, and who has got an affection of the The humerus and the thigh bone have in some in- certain this point before you operate. I removed breast most decidedly schirrus; the glands of the axstances been broken in cancerous patients under such the breast and diseased axillary glands of this lady, illa are enlarged, and there are a few slightly so on circumstances. I remember seeing an old woman ly- but the disease returned in the part, and she died, the side of the neck. She is now about eighty-four ing in bed, who had been affected with cancer for as nearly as possible, in a year from the time years of age, and I do not imagine that when she many years, and in whom the thigh was broken when she had first discovered the tumour in her dies it will be of cancer. There are a number of merely from turning in bed. This fracture oc- breast. There are other instances in which the instances where cancers last a great length of curred two or three months before I saw her, at disease lasts a much longer time. I was consult-time, where they have begun at a late period which time she was still in bed with her brokened by a lady, about sixty years of age, a thin, of life. thigh, and apparently no attempt on the part of spare woman, who had got a cancerous affection of nature at repairing the injury.-Some years ago one breast; and the breast so affected was smaller there was a case in this hospital, not of a very old than the other, being shrunk in size. The tumour person-in fact, of a female under fifty years of consisted of a small induration, and was comage; she was here some time, and when she first pletely fixed to the side of the chest. There was came, appeared stout and robust in health. Nearly a deep fold of the skin crossing along the centre. the whole of the sternum, in her case, was affected This fold was about four inches in length, and at by cancerous disease. We had an opportunity of the deepest part about an inch and a half in depth, examining the parts after death, when it was found giving a most singular appearance to the part. that the osseous substance of the sternum had in a There was a single gland disease between the great measure been removed, and a dense schirrous breast and the axilla. Now in this lady the distexture deposited in its place.-Cancerous tuber- ease had existed, apparently in that state, between cles have been known to form even in the brain. six and eight years, and never gave her any pain Such is the nature of the changes which take all that time; and when I saw her it gave her no place in various internal parts of the body in the uneasiness. A patient died in this hospital in advanced stage of cancerous disease. 1829, in whom disease of a decidedly concerous Now the progress of cancerous disease is not al-nature had existed for about twenty years. In ways the same-there are considerable varieties. I have mentioned the progress of it where it appears as a tumour affecting a small part of the mammary gland; but occasionally the same change appears in the entire gland at one and the same time-the whole gland becomes the seat of this patient, the whole of one breast, with the nip- Cancerous affection sometimes arises from external or accidental causes-such as a blow, or some other injury inflicted on the part; but more commonly they appear to arise spontaneouslythat is, from internal causes, the nature and origin of which we cannot exactly trace. It has been made a question, whether cancer was a local or constitutional disease? The meaning of the latter phrase is not very clear, or obvious. I rather think, however, we might say that cancer is at one period a local disease, and at another a constitutional one. When we see a tumour forming in a small part of the mammary gland, in an individual otherwise perfectly healthy-when we see it not disturbing any function, producing no pain, causing no inconvenience of any kind-I think we must conceive there that the disease is simply confined to the part; and in that condition it is clearly a local disease. When we come to a more advanced period, in which we find the disease showing itself more or less generally on various other parts of the body-when organs distant from I that primarily affected become the seat of disease TO CORRESPONDENTS. Subscribers wishing to complete their sets of the S. R. has our thanks, and his proposition shall STAMPED EDITION OF THE MEDICAL TIMES. STAMPED EDITION is now ready. The Stamped Copies will be the Hon. George Byng, Comptroller of the Household; Mr. Hawes, the Whig member the Bill, as Chairman. This is keeping the for Lambeth, and Mr.'Warburton, the father of Word of promise to the ear, and breaking it to the hope; it is a seeming compliance with the or may be obtained direct from the Office, by forwarding the Sub demand for reformation, but a real denial of FOR A YEAR S. d. 17 4 justice. If the Act required revision, a comW. B. F. will much oblige by an occasional contrimittee should have been appointed who were bution: medical news is always acceptable, and Thirty Weeks Subscription, or any Gentleman wishing to be sup A Half Sovereign (which may be sent for a single postage) will pay unbiassed, and unprejudiced-a committee who, he will perceive that we have availed ourselves or what period he thinksest post, fit the art of Saberip from their knowledge of the subject they were tion for he thinks proper, and ask of the Postmaster an of that contained in his last letter. We will order on the London Post-Office in favour of the Proprietors of the to inquire into, could give that weight to the send down what he requests, if he will oblige ducted from all Subscriptions of six months and upwards. It will be evidence which it properly deserved. Messrs. 'Medical Times. This order will cost sixpence, which may be de us by distributing them. furnished upon a sheet of letter paper, in which the Subscriber can write his name, address, and post-town. He has then only to fold it NAVIS. By a recent regulation, Assistant-Sur- into the form of a letter, direct it Medical Times, 10, Wellington Byng and Gore may be, and we have no Street North, Strand, London," and return it into the hands of the geons in the Navy have to pass the first year as Postmaster. The order will he complied with by return of post, probational, and at the end of that time, whe-THE Medical News-Valuable Lectures now in course of the best modes of advancing its study? Mr. doubt are, very respectable persons in their HE MEDICAL TIMES contains way, but what do they know of Anatomy, or ther they be appointed to a ship or hospital the Surgeon of the same has to certify as to the Assistant-Surgeon's fitness. If not " found wanting" in professional skill or moral conduct, he receives his appointment. Brodie, Howship, Velpean, &c.) Original Scientific Papers-Hospital H., OF PARIS.-We await his communications. Z's letter is full of cleverness, but so inapplicable that we hardly know how to use it. Why not sketch a Portrait? Z. has all the talent, and free, to the OFFICE, Wellington-street North, Strand, London. Hawes is certainly a Member of the House of Commons, but others might have been selected who knew more of the matter. As to Mr. Warburton, but little can be said. For a man to sit as judge upon his own follies and mis if he would adapt his contributions to the spirit THE MEDICAL TIMES. takes truly out Herod's Herod, and is a striking of the Medical Times, they would be regularly inserted. PORTRAIT OF MR. PETTIGREW.-A gentleman ing that he (Mr. P.) has placed his name among as to allow his name to be mentioned at all in THE ANATOMY AСТ. instance of the coolness for which Mr. Warburton has been so often celebrated. It may be "philosophic," but it certainly is consosigning himself C. H. Rawlins, has taken up THE immense importance of a clear and nant neither with justice or decency. The the cudgels for Mr. Pettigrew. We have at comprehensive knowledge of the minute struc- number of witnesses was limited, and Dr. present only space for the second paragraph. ture of the human frame, as a preparatory step Somerville, whose deeds were the subject of Mr. Rawlins loquitur," you commence by stat- in the study of diseases which are incidental to remark, was present at the inquiry. Altothose of the most eminent of the profession-humanity, as guiding diagnosis of their cha- gether it has been a packed affair, and as the this I (Mr. R.) beg to deny." After this, well racter, and directing their judicious treat- Committee have finished their labours, we may may Pettigrew exclain " save me from my friends!" We will endeavour to find room for ment, has rendered the working of the law by hope soon to know the result of their sapient which opportunities are given for the study of deliberations. Rumour, with its hundred Anatomy, a matter of interest to ourselves, tongues, has been, as usual, busy; and it has and of vital import to the public. As the been hinted that Dr. Somerville will be referred practitioner is skilful, so is the public health to in the Report in a most marked manner. secure-in proportion to his knowledge will What the general tenor of that report will be, be his success in the treatment of disease. we may sadly anticipate, when we recollect As the basis of this knowledge is to be obtained, the parties who conducted the examination, and obtained alone, in the dissecting-room, it and the chairman who presided, he himself becomes, as we said, not a professional, but a being the parent of the Anatomy Act, and a public question-not a matter of private ag-large shareholder in the Joint Stock Gowergrandizement, but a source of national weal or street College. But we will not meet evils halfwoe-whether or not fitting opportunities are way, unless it be to avoid them, and may, thereafforded for the complete inculcation of that fore, postpone further remark until the publiknowledge, without which medicine would be cation of the embryo Report. but vague theory, or, still worse, but rampant empiricism. Impressed with this conviction, we have before directed attention to the existing law upon this important point, and in dilating upon the vices of the Anatomy Act, endeavoured to force conviction of its imperfections upon the minds of those who, from cupidity or ignorance, were unwilling to give a thought to its ameBut although much had to be overlioration. come, yet the weight of the evils, and their steady and repeated avowal, had the effect of forcing an inquiry into the imperfect law, and, as we announced in our last, a Committee was appointed to take into consideration the working of the Anatomy Act. We W. T., BRISTOL.-A Post-office order is perhaps those who formed this conclave, and having had gave, upon private information, the names of the most convenient mode of sending. The cost of it is sixpence, which may be deducted given us the names of Messrs. Byng and Gore, from the quarter's subscription. STUDENT.-These are plate-giving times. Mr. Dermott's pupils are busy getting up a subscription, of which we expect to hear more anon. T. P. will find the article inserted. We shall always be glad to hear from him. the letter, verbatim et literatim, in our next. INSTITUTION FOR CURING DISEASES OF THE EAR. We have seen the puff-report of the meeting, which has been smuggled into the newspapers, with a number of high-sounding names as having been present. We have no doubt that the Institution is capable of rendering, and does at times render, good service to those who need it; but such service is counter-balanced, if not entirely obscured, by the excessive quackery with which the whole thing is enveloped. We are heartily sorry to find that Dr. Sigmond has allowed his kindness to be so much imposed upon, conjunction with such an "institution!!!" The public are perhaps not aware, that a short time ago, these ear-doctors gave the Coroner several opportunities of pocketing the usual fees!! It is, however, but one of the schemes adopted of late by needy adventurers, of pushing themselves into unmerited notoriety. I. J.-Yes, we admire the consistency of the editor Coroner; his opinions before and after election are well worthy of remembrance. During the time of election he was all liberality-all promise -nothing but a medical Coroner ought to hold the office; after his election, he closes the court becomes anything but liberal-and to crown the climax, makes his poor clerk, neither lawyer nor doctor, hold inquests for him; and when spoken to by the magistrates about it, and asked how he reconciled his opinions with his practices -he declined answering the question!!! Poor little Clark, the Lancet penny-a-liner, has, ever since our exposé of his conduct had such a fit of nervous excitement, that he now dances about not unlike a monkey on a hot plate. we were led to believe that the Members of A TABLE OF MORTALITY FOR THE Showing the number of Deaths, from all causes, Epidemic, endemic, and contagious Diseases of the brain, nerves, and senses 120 A 908 |